Exemptions of respiratory patients to use face masks are not evidence-based, and it may carry associated risks of severe COVID-19

September 30, 2020

There have been many false health news, hoaxes and biased information about the ongoing COVID-19 pandemic circulating on the net, and also in printed media and on TV. However, sometimes confusion and misinformation occur through official channels. And it can have serious consequences.

One of them is the exemption for respiratory patients to use a facemask, mandatory elsewhere for everyone both in shared outdoor and indoor spaces since May 2020. The Spanish and British laws state: "Those persons who present some type of respiratory difficulty that may be aggravated by the use of the mask, and those whose use is contraindicated for health or disability reasons, are excepted from this obligation."

At the Respiratory Effectiveness Group (REG), an independent global group of medical doctors and researchers in Spain, the United Kingdom and many of the EU member states, the United States, Canada and Australia, among others, have reviewed the available evidence.

In an article published today in the European Respiratory Journal (accessible from, one of the most prestigious international journals in the respiratory arena, it was concluded that there is no evidence to support this exception, and that patients with a respiratory disease are at a high risk of suffering severe COVID-19, in Spain, the UK and elsewhere. We must succeed in eliminating this exception.

Dr Joan B Soriano, medical epidemiologist at the Respiratory Dept. of Hospital La Princesa in Madrid, Spain, member of the WHO COVID-19 Clinical Network Knowledge Exchange Team, and primary author stated: “Patients with asthma, COPD or other respiratory diseases should wear the mask without exceptions. If they have respiratory failure or with a feeling of shortness of breath when putting it on, they should most likely limit their activity, especially outdoors.”

Not using a mask to avoid an asthma attack, or exacerbations of COPD, or of other respiratory diseases, due to an alleged increase in inspiratory pressures through a mask, is unfounded.

Professor Sinthia Bosnic-Anticevich, from the Woolcock Institute at The University of Sydney, who is President of REG and also co-author, also stated: “Please, if you or a relative of yours, have asthma, COPD or other chronic respiratory disease, wear a mask to protect yourself and others. This is a new virus and a new disease, but clear information and individual decisions are critical to defeating this pandemic.”

It is estimated there are 545 million people worldwide suffering a chronic respiratory disease, and not wearing a face mask may carry increased risk of personal and group infection.

Note: full citation as:
Soriano JB, Anzueto A, Bosnic Anticevich S, et al. Face masks, respiratory patients and COVID-19. Eur Respir J 2020; in press (

About Respiratory Effectiveness Group

Respiratory Effectiveness Group (REG) is a not-for-profit, investigator-led research and advocacy initiative that brings together respiratory experts from around the world who are pioneering the field of real-life research (both pragmatic trials and observational studies) with a view to establishing best practice methodologies and standards and in doing so raising the quality and profile of the field for the benefit of all stakeholders (patients, clinicians, policy makers, guideline decision makers and drug manufacturers, alike).


Categories: Healthcare, COVID-19
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